Provider Demographics
NPI:1124284914
Name:THREE AFFILIATED TRIBES WHITE SHIELD HEALTHCARE TELEPHARMACY
Entity type:Organization
Organization Name:THREE AFFILIATED TRIBES WHITE SHIELD HEALTHCARE TELEPHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF TELEPHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-938-3459
Mailing Address - Street 1:2 MAIN STREET B
Mailing Address - Street 2:
Mailing Address - City:ROSEGLEN
Mailing Address - State:ND
Mailing Address - Zip Code:58775
Mailing Address - Country:US
Mailing Address - Phone:701-743-4163
Mailing Address - Fax:701-743-4164
Practice Address - Street 1:2 MAIN STREET B
Practice Address - Street 2:
Practice Address - City:ROSEGLEN
Practice Address - State:ND
Practice Address - Zip Code:58775
Practice Address - Country:US
Practice Address - Phone:701-743-4163
Practice Address - Fax:701-743-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND777332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117660OtherPK